Physiotherapy and quality of life of patients in long-term care Postępowanie fizjoterapeutyczne a jakość życia pacjentów objętych opieką długoterminową

Background: The importance of physiotherapy in improving quality of life of patients in long-term care is not yet fully under­ stood. The aim of the study was to assess the quality of life and functional status of patients in long-term care with respect to their rehabilitation. Study design: Cross-sectional. Materials and methods: The study was conducted among a group of 58 individuals. A questionnaire to collect the data con­ cerning rehabilitation, the Barthel scale, VAS and WHOQOL-Bref were used. Results: The functional condition was assessed as moderately heavy and light in 83.9% of participants. More than 70% of pa­ tients rated the quality of life as good and very good. There was no significant relationship between participation in rehabilita­ tion and quality of life of the subjects (p = 0.35). There was a monotonic relationship between the social domain of quality of life and satisfaction with rehabilitation (r=0.34, p = 0.01). There was a significant correlation between the quality of life and BMI, education, pain and level of functional efficiency assessed using the Barthel scale. Conclusions: The majority of the studied nursing-home residents participated in rehabilitation and were satisfied with it, which positively affected the quality of life in terms of social relations.


INTRODUCTION
Long-term care is an issue that is be ing m ore and m ore frequently tack led by scientists and clinicians. On the one hand, the growing interest in this subject is due to economic rea sons (the desire to reduce the cost of long-term care along with the rapid increase in the demand for this type o f health service) and on the other hand, the desire to im prove the qual ity o f life o f patients staying at long term care facilities.
The  The need  to define the role o f the physiother  apist in im proving the quality o f life  o f patients in long-term care has be  com e an inspiration to undertake re  search. T he aim o f the study w as to  assess the quality o f life and func tional status o f patients at stationary long-term care facilities with regard to rehabilitation, as well as the rela tionship between dem ographic fac tors and quality o f life.

Study participants
The study w as conducted am ong a group o f 58 people (40 wom en and 18 men) in centres providing long term care in the region o f southern Poland. There was at least one phys iotherapist working at each centre. Respondents could use physiother apy treatments, kinesiotherapy and m assages. Exercise program s were in dividually tailored to the health state, physical fitness and preferences o f the studied seniors and included the fol lowing form s o f rehabilitation: verticalization, gait learning, free active evercises with lightening and load ing, active resistance exercises, bal ance exercises, m assage.
C riteria for exclusion from the study were: the lack o f consent to participate in the study and a phys ical or m ental state preventing the participant to give inform ed an swers. The research was carried out in accordance with the D eclaration o f H elsinki.

Research tools
Questionnaire concerning the rehabilitation The first part o f the questionnaire contained questions defining so cio-dem ographic features (gender, age, number o f children, m arital sta tus, education level, duration o f resi dence at the long-term care facility). The second part concerned participa tion in rehabilitation and satisfaction with its progress, assessed on a scale o f 0 to 10.

The Barthel scale
The Barthel scale allows the assess ment o f functional status o f patients and determines psychophysical ef ficiency o f a subject. The following tasks are evaluated: m eal consum p tion, m ovem ent (from bed to chair and back, sitting down), personal hy giene, using the toilet, bathing the whole body, m oving on flat surfac es, climbing up and down the stairs, dressing and undressing, anal sphinc ter and bladder control. For each task, the exam inee can obtain from 0.5 to 10 points, depending on their level o f independence in perform ing the task. Classifying the tested indi vidual between 86 and 100 points means that s/he is independent, ca pable o f self-care and abilities in this respect are minimally limited. Scores between 21-85 points show the need for partial help, assistance, and the person has a substantially limited ability for self-care. The lowest score between 0 and 2 0 points m eans the exam ined person is unable to func tion independently and requires care o f a third-party9.

The VAS scale
The Visual Analogue Scale (VAS) was used to assess pain severity. The sub jects rated the severity o f perceived pain on a 10 cm scale with the m arked values: 0 (no pain) and 10 (maximal pain), then, using a ruler, the m arked values were read. It was assum ed that the range o f 1 to 3 points is low-intensity pain, 4 to 6 is m oderate pain, and 7 to 10 is severe pain6,10.

Statistical analysis
Distribution of qualitative variables was described by specifying relative and absolute frequencies, while the quantitative variables were described by specifying the mean and standard deviation or median, and lower and upper quartiles (depending on the dis tribution of the feature). N orm al dis tribution of quantitative variables was examined using the Shapiro-Wilk test.
The relationship between analyzed features was examined using Fisher's Exact test, the Kruskall-Wallis test and Spearman'r rank correlation. All ana lyzes were perform ed using the statis tical program m e -SPSS Software ver sion 23, IBM , Armonk. Statistical sig nificance was assum ed at = 0 .0 5 . Daily rehabilitation w as attended by 51 residents (87.93% ). Function al status o f the residents according to the Barthel scale w as evaluated as "very severe" in 9 patients (16.1% ), " m oderately severe" in 31 patients (55.3% ), " light severity" in 16 p a tients (28.6% ).

RESULTS
Over 70% of the patients rated the quality o f life as good and very good. When concerning health self-assess ment, 2 9 .9 % of people were satis fied with their health, 4 5 .6 % were dissatisfied, while X A o f respondents could not clearly determine the level o f satisfaction resulting from health self-evaluation.

DISCUSSION
The concept o f quality o f life is used for the overall assessm ent o f a p a tient's physical, psychological and so cial relations and the environment in which s/he functions. The study of quality o f life can be a valuable ad dition to m edical exam inations, par ticularly am ong patients with chronic diseases, as well as in the elderly p o p ulation. M oreover, they can help de termine the factors leading to the oc currence of health problem s and the care of this group of people, and also indicate the proper direction of ther apeutic action.
The first group o f factors affect ing the quality of life of elderly p eo ple are physiological aspects associat ed with aging, which leads to reduced efficiency and functional deterioration of health15. The second group o f fac tors are psychological because, as re search shows, the mental efficien cy o f individuals reduces significantly with age 16-18. According to the W HO-QO L-BREF questionnaire, these fac tors are: appearance, negative feelings, positive feelings, self-esteem, spiritual ity, religion, thinking, learning, mem ory, concentration. In the next fieldsocial relations -we may distinguish: personal relationships, social support, sexual activity. In assessing the com fort of life by older people, their state of being is of great importance and is associated with the end of profession al activity, financial resources, a sense of security, the home environment, opportunities to acquire new inform a tion and skills, opportunities to partic ipate in recreation and leisure9. Exercise is one o f the factors prevent ing loneliness and social isolation am ong seniors35.
Our study showed no statistically significant relationship between par ticipation in rehabilitation and quali ty o f life. This result may be due to the fact that the majority o f respond ents (almost 90% ) participated in physical exercise and only 1 0 % of the study participants did not take part in them, and therefore, com paring the distribution of the quality of life scale in terms of participation in rehabili tation was difficult. We have shown, however, that people satisfied with the course of rehabilitation assessed their quality o f life higher in terms of the field of social relations. On the oth er hand, people with higher BM I as sessed their quality o f life in terms of the environmental field higher. S o cio-demographic factors also have sig nificant impact on the self-assessment of quality o f life, including age, sex, education, marital status, place o f res-idence15, 19. Our study has shown that people with higher education assess their quality o f life higher in terms of the social and environmental fields.